title: Apathy is an independent risk factor for incident cardiovascular disease in the older individual: a population-based cohort study.
abstract: OBJECTIVE
  Although depression is considered to be associated with cardiovascular disease (CVD), specifically symptoms of apathy have been strongly associated with a history of CVD in recent studies. In this study, we prospectively assess whether symptoms of apathy and depression are independent risk factors for incident CVD and stroke.
  
  
  METHODS
  We carried out a prospective cohort study of 1810 community-dwelling older individuals (70-78 years) without a history of CVD or stroke. Symptoms of apathy and depression were assessed with the 15-item Geriatric Depression Scale. Incident CVD and stroke were assessed after 2 years follow-up. The associations of symptoms of apathy and depression with incident CVD and stroke were analyzed separately using logistic regression analysis.
  
  
  RESULTS
  Symptoms of apathy and depression were present in 281 (15.5%) and 266 (14.7%) participants, respectively. Incident CVD occurred in 62 (3.5%) participants and stroke in 55 (3.1%) participants. Apathy was associated with incident CVD after adjustment for demographics and cardiovascular risk factors (odds ratio (OR) = 2.60, 95% CI = 1.46-4.65). Exclusion of subjects with depressive symptoms yielded a similar OR (2.94, 95% CI = 1.45-5.96, n = 1544). No association was found between depressive symptoms and incident CVD. Neither apathy symptoms nor depressive symptoms were associated with incident stroke.
  
  
  CONCLUSIONS
  Apathy, but not depression, is a strong, independent risk factor for incident CVD. It may be a marker of underlying vascular disease. By its nature, apathy may cause non-adherence to a healthy lifestyle, diminished activities, and possibly even withdrawal from clinical care aimed at improving vascular risk profiles.
authors.affiliation: Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Lisa S M
authors.initials: LS
authors.lastname: Eurelings
authors.forename: Suzanne A
authors.initials: SA
authors.lastname: Ligthart
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: van Dalen
authors.forename: Eric P
authors.initials: EP
authors.lastname: Moll van Charante
authors.forename: Willem A
authors.initials: WA
authors.lastname: van Gool
authors.forename: Edo
authors.initials: E
authors.lastname: Richard
mesh_terms: D000368:Aged; D057565:Apathy; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000523:psychology*; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
keywords: apathy; cardiovascular disease; depression; stroke